HIV: #dattiunacontrollata

Comprehensive sexuality education (CSE) plays a central role in the preparation of young people for a safe, productive, fulfilling life in a world where HIV and AIDS, sexually transmitted infections (STIs), unintended pregnancies, gender-based violence (GBV) and gender inequality still pose serious risks to their well-being. However, despite clear and compelling evidence for the benefits of high-quality, curriculum-based CSE, few children and young people receive preparation for their lives that empowers them to take control and make informed decisions about their sexuality and relationships freely and responsibly. Many young people approach adulthood faced with conflicting, negative and confusing messages about sexuality that are often exacerbated by embarrassment and silence from adults, including parents and teachers. In many societies, attitudes and laws discourage public discussion of sexuality and sexual behaviour, and social norms may perpetuate harmful conditions, for example gender inequality in relation to sexual relationships, family planning and modern contraceptive use. A significant body of evidence shows that CSE enables children and young people to develop: accurate and ageappropriate knowledge, attitudes and skills; positive values, including respect for human rights, gender equality and diversity, and, attitudes and skills that contribute to safe, healthy, positive relationships (see Section 4 – The evidence base for comprehensive sexuality education). 

R Moretti1*, M Cremaschini1, G Brembilla1, F Fenili1, MN Gambirasio2, M Valoti1, M Bardus3, L Suzanne Suggs3 and G Barbaglio4
1Lombardy Region, Local Health Authority of Bergamo, Health Promotion Service
2Policlinico S.Pietro, Unit of Internal Medicine. Ponte San Pietro Bergamo
3University of Italian Switzerland, Faculty of Communication Sciences
4Lombardy Region, Local Health Authority of Bergamo, Health Director

The first AIDS drug was approved on March 19, 1987—but getting there was by no means easy. Here's the story behind the treatment.

New York City’s strategy to end the AIDS epidemic is firmly rooted in science, was developed in conjunction with community activists, and has support from top-level political leaders, Demetre Daskalakis told the 2017 Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle this week.

“When you combine political will, biological interventions and harm reduction, you can get to zero,” he said.

Dr Daskalakis is an unusual public health figure: an infectious disease physician who has delivered testing and vaccination in sex clubs and describes himself as a “queer health warrior”. He is now the deputy commissioner for disease control in the New York City Department of Health and is the architect of the city’s “ending the epidemic” initiative.

The strategy places particular emphasis on identifying undiagnosed individuals and linking them to healthcare; retaining people in care to maximise virus suppression; and facilitating access to pre-exposure prophylaxis (PrEP). Mayor Bill de Blasio and Governor Andrew Cuomo have given political and budgetary support to the initiative, facilitating implementation by a range of government agencies.

The Centers for Disease Control and Prevention is making a big push to get more people at "substantial" risk of getting HIV to start on a daily pill that has been shown to dramatically reduce their risk of infection.

Known as PrEP or pre-exposure prophylaxis, the therapy involves taking a daily pill — Truvada — that makes it more difficult for the virus to establish a permanent infection when a person is exposed to it through sexual contact or injectable drug use. Studies have shown that it can reduce risk by 70 to more than 90 percent. In stunning results released in one study in September, researchers found that 100 percent of participants taking HIV prevention pill Truvada remained infection-free for two years. The study, conducted at Kaiser Permanente in San Francisco, involved more than 600 high-risk individuals, most of whom were men who have sex with men.

PrEP is considered to be among the world's most powerful weapons in ending the AIDS epidemic. Despite numerous advances in fighting the disease in recent decades, HIV remains one of the most devastating health issues in the United States. More than 1 million Americans are living with HIV, and more than 40,000 are newly infected each year.

In September, the World Health Organization radically revised its guidelines for those who should be on HIV anti-retrovirals — greatly expanding the number of those who should be in treatment from 28 million to 37 million.

“I am going to fight them, my patients are going to fight them, and you goddamn well better fight them!” —Dr. Suzanne Phillips in a clip from How to Survive a Plague

It was August 1994, and TAG, the Treatment Action Group (I was a cofounder), had become the most hated AIDS organization in the country, while TAG member Spencer Cox had become the most hated AIDS activist. Hated by other AIDS activists. The “them” in Suzanne Phillips’s rallying cry above were TAG’s activists, and she was railing against “the boys” during a weekly ACT UP meeting after we had shocked “AIDS Inc.” with a letter to the Food and Drug Administration (FDA) asking them not to grant accelerated approval to saquinavir, one of the first protease inhibitors.

We felt that Hoffmann-La Roche, its manufacturer, was abusing the accelerated approval process by rushing saquinavir to market before showing how it could be used in combination with previously approved drugs to extend lives. But by this time in the crisis, the status quo of AIDS patient advocacy, driven by the demands of HIV-positive gay white men (often with their gay doctors) in San Francisco and New York, was “just give us the drugs now and we’ll figure out how to use them.”

While this approach undoubtedly prolonged the lives of many proactive patients with expert docs who attended all the AIDS conferences, it was bound to be a long-term public health fiasco, offering little guidance on best practices for the vast majority of people living with HIV outside of these white gay enclaves.

The HIV, stigma & discrimination booklet

The HIV, stigma & discrimination booklet is for people living with HIV and explains what stigma and discrimination are, makes some suggestions for how to deal with these problems and gives information about your legal rights.

The booklet includes quotes from people living with HIV about their personal experiences of stigma and discrimination, how these experiences have made them feel, and how they’ve responded. The quotes were collected from feedback to NAM and from The People Living With HIV Stigma Survey UK.

The booklet includes sections on:

• HIV in the UK today
• What is stigma?
• What is discrimination?
• What people think about HIV and your own feelings about HIV
• Connecting with others
• Deciding whether to tell people that you are living with HIV, including sexual partners, and people you are close to
• Dealing with stigma and discrimination
• Your rights in health care, the workplace, housing, the media, and with insurance companies
• Getting support and championing your rights

NAM’s Patient Information Subscription Scheme

UK-based HIV and GUM clinics can order copies of HIV, stigma & discrimination, as well as our other booklets and leaflets in the series The basics, through our online portal as part of their patient information subscription.

To find out if your clinic is registered or for information on joining the scheme, please email info@nam.org.uk or call 020 7837 6988.

Thank you!

Thanks to the people living with HIV and members of our review panel for their assistance in updating and reviewing this booklet. In particular: Alastair Hudson, FPA; Christabel Kunda, NAZ; Robert James; Irina Lut, FPA; Vincent Manning, Catholics for AIDS Prevention and Support. NAM is grateful to Stigma Survey UK for permission to reproduce the quotes used in the booklet.

We are also grateful to Janssen and Wandsworth Oasis for funding towards the production of this resource. Our funders have had no control over the design or content of the booklet.

The game-changing HIV prevention drug PrEP looks set to be subsidised on the Pharmaceutical Benefits Scheme (PBS), making it far more accessible and affordable for thousands of users in Australia.

The Pharmaceutical Benefits Advisory Committee (PBAC) will likely advise the government to list Truvada, the commercial name for PrEP, at some stage tomorrow, to ensure it is publicly subsidised.

Despite being proven to be 99 per cent effective at preventing the transmission of HIV, it currently costs hundreds of dollars for a prescription, forcing many to import it from overseas.

Through trials in states such as Victoria, New South Wales, and Queensland, many have been given access to the drug, though a PBS listing would see it become more widely available and affordable.

Chief Executive of the Victorian AIDS Council, Simon Ruth, said he is “hopeful” PBAC will decide to endorse PrEP for subsidy tomorrow.

In the event of this however, he worries there may be issues around the capacity of the pharmacy sector to quickly roll the drug out.

“There will also be issues around the capacity of GPs to prescribe it,” he told the Star Observer.

“There are 8,000 people in the NSW [PrEP] trial and 4,000 in the Victorian trial, so there are at least two thousand guys in Melbourne wanting to access PrEP – in the event of it being subsidised, there will be a lot of people seeking GP appointments very quickly.”

Ruth adds that issues may also arise depending on whether the subsidised drug falls under a s85 prescription or a s100 prescription.

If the former, any GP will be able to prescribe it after ringing Medicare for approval first.

About ViiV Healthcare ViiV Healthcare is a global specialist HIV company established in November 2009 by GlaxoSmithKline (LSE: GSK) and Pfizer (NYSE: PFE) dedicated to delivering advances in treatment and care for PLHIV and for people who are at risk of becoming infected with HIV. Shionogi joined in October 2012. The company’s aim is to take a deeper and broader interest in HIV/AIDS than any company has done before and take a new approach to deliver effective and innovative medicines for HIV treatment and prevention, as well as support communities affected by HIV. For more information on the company, its management, portfolio, pipeline and commitment, please visit www.viivhealthcare.com.

Community health advocates have pressed the Foster City-based HIV drug developer to ramp up marketing of its FDA-approved drug to prevent the AIDS virus.

Any sexual relationship, be it a one-time hook-up or longer term, requires clear communication. Consent -- ongoing, affirmative consent about the sexual activities that will occur should be established; and the level of safety with which both people are comfortable should be negotiated. Should.

Although female sex workers are known to be vulnerable to HIV infection, little is known about the epidemiology of HIV infection among this high-risk population in the United States. 

We systematically identified and critically assessed published studies reporting HIV prevalence among female sex workers in the United States. We searched for and included original English-language articles reporting data on the prevalence of HIV as determined by testing at least 50 females who exchanged sexual practices for money or drugs. We did not apply any restrictions on date of publication. We included 14 studies from 1987 to 2013 that reported HIV prevalence for a total of 3975 adult female sex workers. Only two of the 14 studies were conducted in the last 10 years. 

The pooled estimate of HIV prevalence was 17.3% (95 % CI 13.5-21.9 %); however, the prevalence of HIV across individual studies varied considerably (ranging from 0.3 to 32%) and statistical heterogeneity was substantial (I2 = 0.89, Q = 123; p < 0.001). 

Although the variance across the 14 studies was high, prevalence was generally high (10% or greater in 11 of the 14 included studies). Very few studies have documented the prevalence of HIV among female sex workers in the United States; however, the available evidence does suggest that HIV prevalence among this vulnerable population is high.